I slept good during sleep study with Bipap... but not CPAP

[vdol52]

When I had my last sleep study on the second night when they titrate I remember thinking I was cured because I awakened in the morning feeling refreshed for the first time...ever. My wonderful husband who is my advocate asked them what machine they were using and it was a Bipap machine. However the RX was for CPAP. I have not slept well since even though my AHI is normally below 5.
Why do they test on one machine and the prescribe another. Has anyone else had this experience?
Should I push to get a Bipap. I was titrated at 9.
Thanks,
Victoria

[roster]

In my experience all sleep labs use machines that have BiPAP capability. Now that doesn't mean they will use BiPAP settings. Do you know if BiPAP settings were used during your titration study? I had two studies and a machine with BiPAP capability was used but the settings were all straight CPAP.

BiPAPs are usually only prescribed for patients who require a high pressure (14+). If 9 cm controls your apnea, doctors would be very reluctant to prescribe a BiPAP.

What is currently your AI and leak rate? Do you have the software? The "Detail" chart is the most useful one to check what is going on.

Regards,

[vdol52]

My total AHI for a recent one-week period was 2.8. I do have Encore Pro.

[roster]

My total AHI for a recent one-week period was 2.8. I do have Encore Pro.

What about AI?

If you study some of the detail charts what do they look like?

[roster]

Here is the link to my stats for 5 consecutive nights. Yes they are a month old because I haven't been able to use my card because of an error message even though it is a brand new card. I think this is pretty representat.

I will give you some comments with the understanding that I am talking about an aggressive treatment of apnea as I treat my own case.

12/9 - You had about 10 apneas and 8 hypopneas. This is not bad but I like to see less than 8 apneas and 5 or fewer hypopneas.

12/10 - 6 apneas and 10 hypopneas. This is better, but again I would like to see the hypopnea number down.

12/12 - 4 apneas and 5 hypopneas. Excellent night. This is within my personal target range.

12/13 - Bad night. The report shows AHI = 6.0 which is not good. But, IMO, AHI of 6.0 understates the problem. You had about seven hours with only two apneas and ten hypopneas. That is fairly good, but now comes the problem. You had two non-adjacent hours which were loaded with apneas and some hypopneas. IMO, the seven fairly good hours will not make up for these two very bad hours.

12/14 - The report shows AHI of 4.6 and a doctor might say this is good because it is under 5.0. I disagree vehemently. Similar to the night of the 13th, most of your apneas are clustered in two separate hours. There are also a few too many hypopneas for the way I like to be treated.

Now some things to consider for the next step. We will concentrate first on the four clusters of apneas over the 13th and 14th.

1. Do you remember having any congestion those nights?
2. Do your nasal airways generally feel wide open or do you often have congestion? If so, describe it.
3. Do you awaken at night or in the morning with dry mouth? When in bed, have you noticed mouthbreathing or air pressure leaking out the mouth or cheeks puffing out from the CPAP pressure?
4. This is a difficult question because often we don't know. Your bed partner may have some idea. What positions do you sleep in? Left side/right side/back/stomach? Do you switch between these positions often?
5. Do your know of anything different on the 13th or 14th that might have affected your sleep? This could be diet, exercise, stress, exposure to nasal irritants, etc.

What is the outlook for getting the data card replaced so you can look at current results? Hopefully your supplier will replace it under warranty. I believe a replacement card is about $15 from cpap.com.

Regards,

[rested gal]

In my experience all sleep labs use machines that have BiPAP capability. Now that doesn't mean they will use BiPAP settings.

I agree with rooster. Just because they said the machine they used was a "bipap" doesn't mean they ever used separate EPAP/IPAP adjustments. They probably gave you a regular "cpap" titration, setting the bipap machine to use one straight pressure (EPAP and IPAP set for same single pressure) all the way up to the pressure of "9" they arrived at for you.

Victoria, in a previous topic you mentioned this:

viewtopic.php?p=305804#p305804
Also, I have a neurological disorder that is an instability of the autonomic nervous system. It affects everything from respiration, to digestion. Anything that the autonomic nervous system normally regulates is affected. There aren't many doctors who are aware of this disorder. Dr. Oz is one of them who is.
But there is no treatment.

Perhaps that has something to do with the varying data results you get with "CPAP." If "bad data" nights don't correlate necessarily with how you feel the next day, you might want to just start disregarding the higher AHI nights.

[roster]

..........Perhaps that has something to do with the varying data results you get with "CPAP." If "bad data" nights don't correlate necessarily with how you feel the next day, you might want to just start disregarding the higher AHI nights.

You might be right. In the meantime I have seen Victoria's detail charts for five nights. Based on the charts, it is worthwhile to look into congestion, mouthbreathing/leaking, and positional apnea as possible causes of the apnea clusters. I am hoping there is a simple answer with a simple solution.

RG, Her leak line looks good and flat. If she were mouthbreathing or mouthleaking with the nasal mask, would this be easily picked up on the detail chart of Encore Pro?

Regards,

[rested gal]

RG, Her leak line looks good and flat. If she were mouthbreathing or mouthleaking with the nasal mask, would this be easily picked up on the detail chart of Encore Pro?

Yes, it would.

Your suggestions were good ones, rooster. Hope there's a simple solution for Victoria, too!